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Economic Burden of Anaemia

Study
Results
First analysis [1]
Second analysis [2]
Comment

Anaemia is common in chronic diseases, and in the elderly. It is associated with more severe disease, and with increased mortality. It should follow that it is also expensive. Just how expensive it is is investigated in two reports of a study of an insured population of workers from the USA [1,2].

Study


The basis of the analyses is from retrospective claims data from commercial and Medicare plans, covering over two million employees. The population was selected from only those plans with complete capture of costs, including prescription medicines.

Anaemia was identified from diagnostic, procedure, or drug codes, but excluding acute anaemia. Six specific conditions with known high rates of anaemia were also evaluated, chronic kidney disease, cancer, congestive heart failure, irritable bowel disease, and rheumatoid arthritis, with COPD in the second but not first analysis.

Results


First analysis [1]


During 2000 there were 2.3 million plan members with continuous coverage. In this period there were 81,000 cases coded for anaemia, a prevalence of 3.5%. Using 2.2 million plan members with at least one year of continuous coverage over the years 1999 to 2001, 118,000 patients with a coding of anaemia were matched with 36,000 patients without a coding for anaemia, all of whom made claims during an average of nine months of follow up.

Despite 87% of the anaemic patients having no anaemia-specific treatment (transfusion, erythropoietin, B12 or iron injections), there were significantly more outpatient visits and inpatient days, laboratory tests and emergency room visits for anaemic patients. There were, for instance, one more day in hospital, one more outpatient visit, and three more laboratory tests per patient associated with anaemia. On average, payments per anaemic patient were $14,500, and for non-anaemic patients $9,500.

Second analysis [2]


Other analyses used about 2.2 million plan members with at least one year of continuous coverage over the years 1999 to 2001. Of these, 123,000 had at least one of the six study conditions (5.5% of the total study population), 14,400 (0.64% of the total population) also having anaemia. In the six conditions, average age ranged from 46 years for irritable bowel disease to 53 years for cancer.

The prevalence of the conditions in this population is shown in Figure 1, and the prevalence of anaemia in the specific conditions is shown in Figure 2.


Figure 1: Prevalence of six conditions in an insured population







Figure 2: Prevalence of anaemia in the six conditions






For these six diseases, the direct costs of care were calculated for patients with and without anaemia, using modelling to take account of the probability of those with anaemia having more severe disease, and incurring greater costs because of that. Adjusting for severity halved the anaemia-associated direct costs.

Figure 3 shows the adjusted annual anaemia-associated direct costs modelled for one million people like those in the population studied. They were greatest for cancer and congestive heart failure, but combined for these six conditions, the total annual anaemia-associated cost was $110 million.


Figure 3: Anaemia-associated annual costs per million population






Comment


In terms of the population reported in these studies, most were between 30 and 70 years, and there were somewhat more women than men. The older old were not included because the bulk of the information was coming from an employed population. One person in about 20 had at least one of the six conditions, and 1 in about 160 also had anaemia. Those with anaemia cost more to treat over one year than those without anaemia, even after making allowances for the greater disease severity that accompanies anaemia.

For a hypothetical one million people like this, the burden of anaemia in these conditions was $110 million. In UK terms, with 28 million people in employment, a current exchange rate of $1.75 per £, and making an assumption that costs here are half those in the USA, one would not get much change out of £1 billion. That is more than in the Bandolier piggy bank, and makes independent sensible thinking about anaemia harder, rather than sponsored economic analysis.

References:


  1. AR Nissenson et al. Economic burden of anemia in an insured population. Journal of Managed Care Pharmacy 2005 11: 565-574.
  2. WB Ershler et al. Economic burden of patients with anemia in selected diseases. Value in Health 2005 8: 629-638.

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